I agree.
What Szilagyi says is,
"In its recommendations for caring for transgender and gender-diverse young people, the AAP advises pediatricians to offer developmentally appropriate care that is oriented toward understanding and appreciating the youth’s gender experience. This care is nonjudgmental, includes families and allows questions and concerns to be raised in a supportive environment. This is what it means to “affirm” a child or teen; it means destigmatizing gender variance and promoting a child’s self-worth. Gender-affirming care can be lifesaving. It doesn’t push medical treatments or surgery; for the vast majority of children, it recommends the opposite."
Academy of Pediatrics Responds on Trans Treatment for Kids
WSJ, Aug. 21, 2022
www.wsj.com/articles/trans-gender-pediatric-aap-kids-children-care-surgery-affirm-treatment-11660942086?st=7h5qrjkqi2biz4j
Archived: archive.ph/www.wsj.com/amp/articles/trans-gender-pediatric-aap-kids-children-care-surgery-affirm-treatment-11660942086
She says to "affirm" is "not judgemental" - but it is.
She does not spell it out - but - what is "affirmation" without, at the very least, "social affirmation" aka "social transition"?
- a name change and/or pronoun change
- and/or changes to dress or other aspects of appearance in an attempt to "pass" visually?
That is a judgement: that social affirmation is
neither a neutral act
nor a potentially negative approach but is instead
"promoting a child's self worth".
From the Cass Review Interim Report:
5.19. There are three types of intervention or treatment for children and young people with gender-related distress, which may be introduced individually or in combination with one another:
-
Social transition – this may not be thought of as an intervention or treatment, because it is not something that happens within health services. However, it is important to view it as an active intervention because it may have significant effects on the child or young person in terms of their psychological functioning. There are different views on the benefits versus the harms of early social transition. Whatever position one takes, it is important to acknowledge that it is not a neutral act, and better information is needed about outcomes
-
Counselling, social or psychological interventions – these may be offered before, instead of, or alongside physical interventions. Again, they should be viewed as active interventions which require robust evaluation in their own right.
-
Physical treatments – these comprise puberty blockers and feminising/ masculinising hormones (administered by endocrinologists) and surgery. The latter is not considered as part of this Review since it is not available to those under age 18.
5.20. It should also be recognised that
‘doing nothing’ cannot be considered a neutral act.
Affirmation and Social Transition
Transgender Trend
What is affirmation?
Affirmation, or the ‘gender affirmative’ approach, is the affirmation of a child’s gender identity. In practice this means affirmation of a boy’s belief that he is really a girl, or affirmation of a girl’s belief that she is really a boy.
What is a social transition?
A social transition is when someone decides to live in the role of their chosen sex. This can involve a name change and use of different pronouns. A person’s new gender can be expressed by the use of hairstyles and clothes. It can be full-time, only exhibited in certain settings or just at home. These transitions do not involve any medical, physiologic or hormone intervention.
"What little evidence we do have indicates that affirmation and social transition may fix a child into an identity they may have grown out of if left alone."
Full article:
www.transgendertrend.com/social-transition-and-chest-binding/
Szilagyi goes on to say:
"This isn’t the story that is being told by anti-transgender activists. No European country has categorically banned gender-affirming care when medically appropriate. Contrary to what Dr. Mason and Mr. Sapir claim, the U.K. isn’t moving away from gender-affirming care. It is moving toward a more regional, multidisciplinary approach, similar to what is practiced in the U.S."
Interesting to contrast how "affirmation" is referred to in the Cass Review Interim report:
"Primary and secondary care staff have told us that they feel under pressure to adopt an unquestioning affirmative approach and that this is at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters."
"From the point of entry to GIDS there appears to be predominantly an affirmative, non-exploratory approach, often driven by child and parent expectations and the extent of social transition that has developed due to the delay in service provision."
"Over a number of years, in parallel with the increasing numbers of referrals, GIDS faced increasing challenges, both internally and externally. There were different views held within the staff group about the appropriate clinical approach, with some more strongly affirmative and some more cautious and concerned about the use of physical intervention."
"Clinicians and associated professionals we have spoken to have highlighted the lack of an agreed consensus on the different possible implications of gender-related distress – whether it may be an indication that the child or young person is likely to grow up to be a transgender adult and would benefit from physical intervention, or whether it may be a manifestation of other causes of distress. Following directly from this is a spectrum of opinion about the correct clinical approach, ranging broadly between those who take a more gender-affirmative approach to those who take a more cautious, developmentally-informed approach."
"GIDS staff have confirmed that judgements are very individual, with some clinicians taking a more gender-affirmative approach and others emphasising the need for caution and for careful exploration of broader issues."
"Some secondary care providers told us that their training and professional standards dictate that when working with a child or young person they should be taking a mental health approach to formulating a differential diagnosis of the child or young person’s problems. However, they are afraid of the consequences of doing so in relation to gender distress because of the pressure to take a purely affirmative approach."
"Affirmative model - A model of gender healthcare that originated in the USA which affirms a young person’s subjective gender experience while remaining open to fluidity and changes over time. This approach is used in some key child and adolescent clinics across the Western world."
Other references are specifically to "gender-affirming hormones" rather than affirmation in general.
Cass Review Interim Report
March 10, 2022
cass.independent-review.uk/publications/interim-report/
In further "Journal entries" Cass has clarified and expanded on some issues, including "affirmation vs exploratory" approaches, differential diagnosis, etc.
Entry 6 – Following the interim report (March 2022)
March 29, 2022
"I have been clear that there needs to be better agreement and guidance about the appropriate clinical assessment processes that should take place. Current debates around gender can create an artificial binary opposition between explorative and affirmative stand points. This is an oversimplification of a complex issue and can sometimes create misunderstandings of the kind I have referred to. In practice clinicians have a spectrum of approaches and do not necessarily see these models as mutually exclusive.
I have also noticed some debate around the inclusion of the need for a diagnosis and differential diagnosis, and whether that means we are pathologising gender identity or seeing it as a mental health problem. I think it is worth clarifying what is meant by these terms.
Applying medical thinking to gender identity isn’t required until and unless a young person needs treatment. The regulations are particularly tightly defined when a doctor is considering prescribing medication, and especially medication that may have some life-long effects. Doctors then have a professional obligation to go through a process of ensuring that it is appropriate for the health needs of the individual, which means making a positive diagnosis (what the condition is) and a differential diagnosis (what the condition isn’t). This applies in all areas of medicine.
The process of differential diagnosis is neutral in terms of outcome – it’s not about preferring one diagnosis over another; it’s just about getting it right. It isn’t about trying to rule out every conceivable explanation before confirming any particular diagnosis – only about ruling out other diagnoses that might be likely for that individual, or where getting it wrong and missing another diagnosis could have serious consequences. Achieving this involves taking a holistic, considered approach to each individual about the possible causes of their distress and identifying the most appropriate pathway for them. This must always be done with sensitivity and in partnership with the young person and their family."
cass.independent-review.uk/entry-6-following-the-interim-report-march-2022/
Entry 7 – Research
July 28, 2022
"Improving the level and quality of evidence will enable young people seeking NHS support, their families and carers, and clinicians to have better information to help them determine the best support and interventions for them as individuals."
cass.independent-review.uk/entry-7-research/
Entry 8 – Beyond the Headlines
August 18, 2022
"This challenge is not unique to the NHS; speaking to colleagues in Finland, they describe a similar picture. When they opened their tertiary level gender identity service, others were reluctant or did not feel they had the capability to work with individuals with gender identity issues. Across schools, social services and local children’s mental health services, staff did not feel that they had sufficient knowledge or expertise to explore gender identity or even address other issues that these young people might be struggling with. I am told that this has now changed completely; other professionals recognise that it is not helpful to exceptionalise gender identity issues, and that they have the transferrable skills to work in this area. There are useful lessons that we can take from their experiences."
cass.independent-review.uk/entry-8-beyond-the-headlines/
To return to Szilagyi, note what she says here, referring to the failed AAP resolution calling for a review of evidence:
Why We Stand Up for Transgender Children and Teens
August 10, 2022 - AAP Voices Blog
"At this year’s Leadership Conference, there was a second resolution on transgender youth, offered by five pediatricians who disagree with the Academy’s approach to gender-affirming care. . . .
However, we don’t need a formal resolution to look at the evidence around the care of transgender young people. Evaluating the evidence behind our recommendations, which the unsponsored resolution called for, is a routine part of the Academy’s policy-writing process. Critics of our gender-affirming care policy mischaracterize it as pushing medical or surgical treatments on youth; in fact, the policy calls for the opposite: a holistic, collaborative, compassionate approach to care with no end goal or agenda. The AAP Section on LGBTQ Health and Wellness, as well as other groups within AAP’s membership, are engaged in numerous conversations about transgender care and we expect those discussions to continue. It is an important conversation, and one the AAP is eager to lead.
Gender-affirming care is a top issue of concern for pediatricians, and in fact, one of the top ten resolutions receiving the most support at the meeting was the one on expanding education and training for pediatricians on gender-affirming care. I was heartened to see this resolution pass with such broad support."
www.aap.org/en/news-room/aap-voices/why-we-stand-up-for-transgender-children-and-teens/
To put Szilagyi's claims about the AAP being "evidence based" in context, her WSJ article is in response to an earlier WSJ article that refers to the "second resolution" mentioned in her AAP blog post.
You have to read this article to understand how lacking in due diligence the AAP is and how determined to shut down debate about the evidence of "social contagion" playing a role in the massive increase in numbers of children presenting with "gender confusion", "gender identity issues", etc.
The American Academy of Pediatrics’ Dubious Transgender Science
WSJ Aug. 17, 2022
Julia Mason and Leor Sapir
A spate of headlines this month declared that America’s surge in transgender identification wasn’t being caused by a social contagion. These articles were prompted by a new study by Jack Turban and colleagues in Pediatrics, flagship journal of the American Academy of Pediatrics. The study claimed that social influence isn’t the reason that as many as 9% of America’s youth now call themselves transgender. Thus, Dr. Turban argues, efforts in conservative states to regulate on-demand puberty blockers, cross-sex hormones and surgery must be resisted.
Yet Dr. Turban’s study is deeply flawed and likely couldn’t have survived a reasonable peer-review process. The swift response from the scientific community made both points clear—with even those who support hormones and surgery for gender-dysphoric youth noting that Dr. Turban’s shoddy science undermined their cause.
Nevertheless, the media have promoted his work as a refutation of the claim that the wildfire spread of transgender identity is an example of social contagion—a phenomenon in which members of a group (mostly young and female) mutually influence one another’s emotions and behavior.
The Turban study rejects the social-contagion theory on the grounds that more biological boys than girls identified as trans in 2017 and 2019, according to data collected from 19 states by the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey. But the researchers who helped design the CDC questionnaire explicitly warned that youths who identify as transgender may list their sex as their gender identity, making it impossible to discern who is male-to-female or female-to-male (a limitation Dr. Turban has acknowledged in the past).
In this latest study, he cites three sources suggesting that respondents interpret “sex” as “sex assigned at birth”—even though none of those studies says anything of the sort. To use a flawed sex statistic in an attempt to set aside the well-documented phenomenon of gender-dysphoric female teens’ flooding clinics is so amateurish that one can’t help but suspect bad faith.
The AAP has been giving Dr. Turban a platform for years, despite the mistakes that plague his research. Pediatrics published his highly flawed 2020 study alleging that puberty blockers reduce suicide in teens. The journal even chose the article as its “Best of 2020” despite receiving rebuttals that pointed out the rate of attempted suicide was twice as high among the puberty-blocked group and Dr. Turban hadn’t controlled for the possibility that better mental-health outcomes might be the result of factors other than hormonal intervention.
In his correspondence with physicians who asked how such a study could be named best of the year, Lewis First, editor in chief of Pediatrics, said that award is based on “website views and article downloads,” not “editorial choices.” In response to a rebuttal from one of us (Julia Mason), who warned that the AAP was encouraging the misleading idea that sex can literally be changed, a reviewer said that her statement shouldn’t be published as it could be “offensive to the pediatric readership of the journal.” Pediatrics seems to be basing its editing choices on political calculation and the sensibilities of trans-identified teens. One wonders how many pediatricians who rely on the journal for professional guidance are aware of these criteria.
The AAP has ignored the evidence that has led Sweden, Finland and most recently the U.K. to place severe restrictions on medical transition for minors. The largest pediatric gender clinic in the world, the U.K.’s Gender Identity Development Service, was ordered to shut down in July after an independent review expressed concerns about clinicians rushing minors to medical transition. Medical societies in France, Belgium and Australia have also sounded the alarm. The U.S. is an outlier on pediatric gender medicine.
A major reason for this is the capture of institutions such as the AAP. Last year a resolution was submitted to the AAP’s annual leadership forum to inform the academy’s 67,000 members about the growing international skepticism of pediatric gender transition. It asked for a thoughtful update to the current practice of affirmation on demand.
Even though the resolution was in the top five of interest based on votes by members cast online, the AAP’s leadership voted it down. In their newsletter, they decried the resolution as transphobic and noted that only 57 members out of 67,000 had endorsed it. The following year, however, when only 53 members backed a resolution that supported affirmative intervention, the AAP allowed the motion to go through, saying that the previous year’s measure was “soundly defeated” while this year’s received “broad support.” When members submitted another resolution to conduct a review of the evidence, the AAP enforced for the first time a rule that shut down member comments, effectively burying it.
The AAP has stifled debate on how best to treat youth in distress over their bodies, shut down efforts by critics to present better scientific approaches at conferences, used technicalities to suppress resolutions to bring it into line with better-informed European countries, and put its thumb on the scale at Pediatrics in favor of a shoddy but politically correct research agenda. Its preference for fashionable political positions over evidence-based medicine is a disservice to member physicians, parents and children.
Dr. Mason is a pediatrician. Mr. Sapir is a fellow at the Manhattan Institute.
www.wsj.com/amp/articles/the-american-academy-of-pediatrics-dubious-transgender-science-jack-turban-research-social-contagion-gender-dysphoria-puberty-blockers-uk-11660732791
Archived: archive.ph/www.wsj.com/amp/articles/the-american-academy-of-pediatrics-dubious-transgender-science-jack-turban-research-social-contagion-gender-dysphoria-puberty-blockers-uk-11660732791
Possibly Sapir is clutching at straws when he says:
"In response to a Wall Street Journal op-ed that I co-authored criticizing the American Academy of Pediatrics’ approach to pediatric gender medicine, Moira Szilagyi, president of the AAP, has written that “gender-affirming care . . . doesn’t push medical treatments or surgery; for the vast majority of children, it recommends the opposite.”
This is a welcome development, and marks a reversal of the AAP’s previous policy."
A Victory for Child Welfare?
Did the American Academy of Pediatrics tacitly reverse its stance on pediatric gender medicine?
Leor Sapir
August 22, 2022
www.city-journal.org/did-the-aap-just-reverse-its-gender-transition-policy
Where is the AAP's evidence that, "for the vast majority of children, (gender-affirming care) recommends the opposite (of medical treatments or surgery)"?
The "second resolution" was asking for evidence: the AAP buried it and Szilagyi appears, in her WSJ "rebuttal", to refer to Dr. Mason and Mr. Sapir as "anti-transgender activists".
Szilagyi says:
"Gender-affirming care is a top issue of concern for pediatricians, and in fact, one of the top ten resolutions receiving the most support at the meeting was the one on expanding education and training for pediatricians on gender-affirming care."
Given the opportunity, perhaps they would also have voted as enthusiastically for a resolution calling for a better evidence base?
I do hope that lots of them get to see Mason and Sapir's WSJ article. It is nothing short of negligent that the AAP is promoting Turban's dubious research.
This was for me the most shocking revelation by Mason and Sapir:
"In his correspondence with physicians who asked how such a study could be named best of the year, Lewis First, editor in chief of Pediatrics, said that award is based on “website views and article downloads,” not “editorial choices.” In response to a rebuttal from one of us (Julia Mason), who warned that the AAP was encouraging the misleading idea that sex can literally be changed, a reviewer said that her statement shouldn’t be published as it could be “offensive to the pediatric readership of the journal.” Pediatrics seems to be basing its editing choices on political calculation and the sensibilities of trans-identified teens. One wonders how many pediatricians who rely on the journal for professional guidance are aware of these criteria."